Assessment of Injuries Sustained in Mixed Martial Arts Competition James F

(aspects of sports medicine) Assessment of Injuries Sustained in Mixed Martial Arts Competition James F. Scoggin III, MD, Georgiy Brusovanik, MD, Michael Pi, MD, Byron Izuka, MD, Pierre Pang, MD, Seren Tokumura, BS, and Gaetano Scuderi, MD ABSTRACT referred to an emergency depart- match. Far from the “tough man” Mixed martial arts (MMA) competi- ment when necessary, and follow- competitions that were popular 20 tions have gained much popularity, up was recommended as needed. years ago, modern MMA competi- and the sport is watched by many Among the 232 exposures were tions are complex athletic events, 55 injuries: 28 abrasions and lacera- millions annually. Despite ongoing often involving elite athletes. controversy, there have been no tions (6 requiring on-site suturing or objective studies of the injuries sus- referral to an emergency department In the events included in this tained in MMA based on on-site eval- for suturing), 11 concussions (4 with study, competitors included former uation. In the study reported in this retrograde amnesia), 5 facial inju- division I college wrestlers, former article, we attempted to delineate ries (2 nasal fractures, 1 tympanum college and professional football injury patterns for MMA participants. rupture, 1 temporomandibular joint players, former Olympic medalists We conducted an observational sprain, 1 Le Fort fracture), and 11 in wrestling, and black belts in cohort study of MMA competitions orthopedic injuries (3 metacarpal a variety of martial arts. MMA held in Hawaii between 1999 and 2006. The study included 116 bouts, involving 232 “exposures” and 179 male participants between ages 18 “...modern MMA competitions are and 40. All the fighters were examined by 1 of 4 physicians, both before complex athletic events, often involving and after each bout. Fighters were elite athletes.” Dr. Scoggin is Assistant Clinical Production Professor, John A. Burns School of Medicine, Honolulu, Hawaii, and is an injuries, with 1 confirmed fracture; requires skills in a variety of mar- orthopedic surgeon in private practice 1 acromioclavicular separation; tial arts and grappling techniques at Honolulu Sports Medical Clinic, Inc., 1 traumatic olecranon bursitis; 1 and the highest level of athleticism Honolulu, Hawaii. elbow subluxation; 1 midfoot sprain; Dr. Brusovanik is Orthopedic Resident, (Figure 1). Department of Orthopedics, University of 1 aggravation of elbow medial collat- The sport has rapidly grown in Hawaii, Honolulu, Hawaii. eral ligament sprain; 1 elbow lateral popularity. Many millions of fans Dr. Pi is Staff Anesthesiologist, Kapiolani collateral ligament strain; 1 trapezius watch MMA competitions annu- Medical Center, Honolulu, Hawaii. strain; 1 Achilles tendon contusion). ally on pay-per-view TV in the Dr. Izuka is Assistant Clinical Professor, We describe the injuries sustained John A. Burns School of Medicine, United States, and the sport has a Honolulu, Hawaii, and is an orthopedic in MMA competition to make com- surgeon in private practice at Kapiolani parisons with other sports. We dis- notable long history of popularity Medical Center, Honolulu, Hawaii. cuss distribution and mechanism of in Brazil and Japan. Controversy Dr. Pang is Assistant Clinical Professor, injuries as well as injury incidence with regard to early “open” weight John A. Burns School of Medicine, based on on-site evaluation in MMA. Honolulu, Hawaii. Ms. Tokumura is classes and lack of striking rules Medical Student, John A. Burns School has followed the sport, particularly of Medicine, Honolulu, Hawaii. ixed martial arts in the United States, and a ban of Dr. Scuderi is Assistant Clinical Professor, Stanford School of Medicine, Palo Alto, (MMA) competitions the sport has been attempted in California, and is an orthopedic surgeon incorporate elements various states. Despite the growing in private practice, Jupiter, Florida. Mof boxing, kickbox- popularity and controversy, there Address correspondence to: Georgiy ing, wrestling, jiujitsu, and other is a paucity of data on the types of Brusovanik, MD, Department of martial arts in organized events. injuries that occur in MMA com- Orthopedics, University of Hawaii, 1356 Athletes are allowed to punch, petition. Lusitana St, Honolulu, HI 96713 (tel, 305- kick, and use wrestling-style take- Bledsoe and colleagues1 reviewed Copyright467-5678; fax, 808-537-4667; goshab@ bellsouth.net). downs and jiujitsu-style submission injury data from the Nevada State holds in an attempt to win bouts by Athletic Commission and found Am J Orthop. 2010;39(5):247-251. Copyright Quadrant HealthCom Inc. 2010. knockout, submission, or judges’ an overall rate of 28.6 injuries All rights reserved. decision based on control of the per 100 fight “participations” (a May 2010 247 Assessment of Injuries Sustained in Mixed Martial Arts Competition sustained 55 injuries. Each bout involved 2 fighters, though some fighters competed in more than 1 bout per event. The 55 injuries were classified as abrasions and lacerations (n = 28), concussions (n = 11), facial injuries (n = 5), or orthopedic injuries (n = 11). Minor contusions and superficial hematomas in the absence of other injuries were not included in this study. The largest injury group, abrasions and lacerations, consisted of 1 deep tongue laceration (required suturing in the ED); 6 forehead lacerations (1 required suturing); 11 Figure 1. Mixed martial arts competition. lacerations to eyebrows or eyelids and 1 corneal abrasion; 4 lacera- “participation” is defined as one of injured areas was performed tions to the nasal bridge; and 6 lac- competitor in one bout). To our as indicated. Additional follow-up erations to the knees, scalp, or chest knowledge, studies of prefight information was included as appro- or superficial abrasions that did not and postfight evaluations have not priate. For this discussion, a bout is require formal medical care. Six of been conducted by on-site physi- defined as an in-the-ring competi- the fighters were sent to the ED for cians. In this article, we describe tion between 2 athletes according suturing or wound care. injuries sustained by profession- to the rules of the event. An expo- Of the 11 concussions, 7 caused al MMA competitors in Hawaii sure consists of 1 athlete in 1 bout. brief (<15 seconds) loss of con- events during a prospective assess- The fighters were male, medically sciousness; the other 4 were charac- ment period (1999–2006). In the fit professional athletes, ages 18 to terized by retrograde amnesia. In 4 study, we attempted to delineate 40, with experienceProduction in various mar- cases, computed tomography (CT) the injury patterns of MMA com- tial arts and/or wrestling. of the head was performed after the petitions by analyzing a database fight. All CT scans were negative compiled by 4 physicians who were for cerebral hemorrhage, per the ringside physicians at these events. RESULTS radiologist’s report. The study included 116 bouts (232 The facial injury group consisted MATERIALS AND exposures) at professional MMA of 2 nasal fractures, 1 tympanic METHODS events held in Hawaii over 7 years membrane rupture, 1 Le Fort frac- Data were collected for 116 bouts (1999–2006). The 49 fighters who ture, and 1 temporomandibular at 12 separate professional MMA participated in the 116 bouts joint sprain. events held in Hawaii over 7 years (1999–2006). Competitions were hosted by MMA organizations. Competitors came from Hawaii, the continental United States, Japan, Brazil, and elsewhere. Each fighter was examined before and after each bout. Ringside care was provided by a team of 4 physicians: emergency department (ED) physician, orthopedic surgeon, oph- thalmologist, and anesthesiologist. Data collected included age, past Copyrightmedical and surgical history, cur- rent medical problems, and physi- cal examination data. After each fight, each fighter was asked about injuries, and directed examination Figure 2. Jiujitsu arm bar. 248 The American Journal of Orthopedics® J. F. Scoggin III et al our review, the most common inju- Table. Comparative Injuries per Exposure in ries, in decreasing order, are abra- Martial Arts Competitions sions and lacerations (51% of inju- Sport Injuries Per Exposurea ries), concussion (20%), orthopedic injuries (20%), and facial injuries Mixed martial arts Present study 0.237 (9%). There were no deaths. There Bledsoe et al1 0.286 was no severe trauma requiring Karate7 0.31 immediate resuscitative measures. Karate8 0.29 Karate9 0.214 To our knowledge, there were no Boxing4 0.25 injuries that precluded eventual Taekwondo6 0.0629 return to competition. aExposure = single participation in a bout. In addition to the 4 categories of injuries already described, there were superficial contusions and All orthopedic injuries were eval- in other sports, and counting ecchymoses. Because contusions uated, after the competition, by each bout as a single exposure, and ecchymosis are usually con- a board-certified orthopedic sur- we found 232 exposures among sidered minor injuries not requir- geon, with recommendations for 179 male competitors. There were ing follow-up, we did not include follow-up as appropriate. The most 55 injuries in 49 fighters during them in this study, which is consis- common orthopedic injuries were the 116 recorded bouts. Of these tent with studies of other contact to the metacarpals, with 1 frac- injuries, 28 were abrasions or lac- sports. ture requiring closed reduction and erations, 11 were concussions, 5 All data were gathered by ringside casting. The other 2 athletes with were facial injuries, and 11 were physicians with experience in the metacarpal injuries were referred orthopedic injuries. In summary, unique medical aspects of MMA for follow-up with their primary the injury-per-exposure rate was competition. After each fight, each care physician and were lost to fol- 0.237, and the risk for injury was fighter was reevaluated in the lock- low-up. The most common mecha- 0.27 per athlete. This risk for inju- er room with directed examination nism of metacarpal injury was a ry per exposure was compared of any suspected injured areas.

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